Self-concept Responses and
Dissociative Disorders
Chapter 18 Nur 305
Rochelle Roberts RN MSN
Self-concept development factors
• Interpersonal and cultural
experiences generate
positive feelings and a
sense of worth
• Perceived competence in
areas valued by the
individual and society
• Self-actualizationrealizing one’s full
potential
The Self & Significant Others
• “Learning about self
from the mirror of
other individuals.”
(Sullivan)
• Parental influence
• Friends influence
• Cultural practices and
social class
Self-Perceptions
• Influenced by needs,
values, and beliefs
• Self-perceptions are
difficult to change
• negative self-concept
associated with narrow,
distorted perceptions.
• positive self concept is
associated with self
actualization
Body Image
• Is dynamic and
constantly changing
• Central to one’s selfconcept
• An anchor for selfawareness
Self-Ideal
The person’s perception
of how to behave,
based on certain
personal standards.
Formulation of the selfideal begins in
childhood and is
influenced by
significant others.
Self-Esteem
• A person’s personal
judgment of his or her
own worth, based on
how well behavior
matches up with selfideal.
Role Performance
• Roles are sets of
socially expected
behavior patterns
associated with a
person’s functioning in
different social groups.
• Roles overlap.
Personal Identity
• Identity is the
awareness of being
oneself, derived from
self-observation and
judgment.
• Different from selfconcept in that it’s a
“feeling of distinctness
from others.”
Description of a Healthy
Personality
• A person who is able
to perceive both self
and the world
accurately.
• This insight creates
harmony and peace.
Qualities of a healthy personality
based on developmental theory
• Positive and accurate
body image
• Realistic self-ideal
• Positive self-concept
• High self-esteem
• Satisfying role
performance
• Clear sense of identity
Behaviors Associated with Low
Self-Esteem
•
•
•
•
Self-criticism
Guilt and worry
Postponing decisions
Denying oneself
pleasure
• Disturbed
relationships
• Self-destructiveness
Identity Diffusion
• Is the failure to
integrate childhood
identifications into a
harmonious adult
psychosocial identity.
• A person may fail to
establish their own
identity and instead
fuse their pesonality
onto another.
Depersonalization
• Is the subjective
experience of total or
partial disruption of
one’s ego and
disorganization of
one’s self-concept.
• Involves withdrawal
from reality and true
alienation from
oneself.
Behaviors Associated with
Depersonalization
• Alienation
• A heightened sense of
isolation
• Disturbed body image
• Auditory and visual
hallucinations
• Confusion
• Disturbed thinking
• Multiple personality
disorder
Feeling of unreality about
parts of the body.
Feelings of insecurity
Loss of impulse control
Disturbance of memory
Dreamlike view of the world
Feeling sof loss of identity
Predisposing factors affecting
self-esteem
• Genetic
• Environmental
• Parental rejection- failure to be loved and to
love
• Feelings of inadequacy
• Repeated defeats and failures
• overpossesiveness
Factors affecting role
performance
• Gender stereotypes
may heighten role
strain
• Work role stain;
women perform dual
roles.
Factors affecting Personal
Identity
• Constant parental
intervention
• Parental distrust
• Adolescent peer group
identity
Precipitating Stressors
Trauma- physical, sexual, and psychological
abuse in childhood
Role strain- developmental and health-illness
transitions.
Biological- biochemical imbalances, oxygen
deprivation, alcohol, and drugs.
Coping Resources
• All people have some
areas of personal strength,
no matter how disturbing
their behavior.
• Sports, hobbies,
intelligence, expressive
arts, education,
imagination, creativity,
and self-care
Coping Mechanisms
• Temporary escape
category (exercise, sports)
• Temporary substitute
identity (joining a club)
• Confronting or
challenging something
(risk-taking and bigotry)
• Adopting an identity
desired by others (identity
foreclosure)
Ego defense mechanisms
• Patients with alterations in
self-concept may use these
to protect themselves from
confronting their own
inadequacies.
• Patients may use
mechanisms of isolation,
projection, displacement,
and acting out.
Nursing diagnoses
•
•
•
•
•
Disturbed body image
Readiness for enhanced self-concept
Low self-esteem
Ineffective role performance
Disturbed personal identity
Medical diagnoses
• Identity problem- uncertain about multiple
issues related to identity
• Dissociative amnesia- inability to recall
certain personal information
• Dissociative fugue- sudden unexpected
travel away from home with inability to
recall one;s past.
Medical diagnoses cont.
• Dissociative identity disorder(multiple
personality disorder)-presence of 2 or more
distinct identitites or personality traits.
• Depersonal disorder- persistent experiences
of feeling detached from one’s body or
mind. (feeling one is in a dream)
Medical treatment for
dissociative disorders
• Sodium pentobarbital
and hypnosis are used
to facilitate the
recovery of repressed
and dissociated
memories.
• Psychotherapy helps
patients work through
and control access to
traumatic memories.
Nursing goals and interventions
• Level 1: expand the
patient’s self-awareness
• Interventions:
• listen to the patient and
develop a trusting
relationship
• Identify the patient’s ego
strength
• Increase pt’s participation
in the relationship
Nursing goals and interventions
(cont.)
• Level 2: encourage the patient’s selfexploration
• Encourage the patient to express emotions
and thoughts.
• Help patient clarify his concept of self
• Respond empathically not sympathetically
to patient.
Nursing goals and interventions
cont.
• Level 3: assist the patient’s self-evaluation
• Help the patient define the problem clearly.
• Explore the patient’s adaptive and
maladaptive coping responses to the
problem.
Nursing goals and interventions
cont.
• Level 4: Help the patient form a realistic
plan of action
• help the patient identify alternative
solutions.
• Help the patient develop realistic goals
Nursing goals and interventions
cont.
• Level 5: help the patient become committed
to his decision and then achieve goals.
• Reinforce the patients strengths and skills.
• Provide the patient with support and
positive reinforcement in effecting and
maintaining change.
• Both the patient and nurse must allow
sufficient time for change.
Evaluation
• Overall success
achieved in nursing
care can be determined
by eliciting the
patient’s perception of
his/her own personal
growth